Multimorbidity and exit from paid employment: the effect of specific combinations of chronic health conditions

Objectives:
This study aimed to assess the association between multimorbidity and exit from paid employment, and which combinations of chronic health conditions (CHCs) have the strongest association with exit from paid employment.
Methods:
Data from 111,208 workers aged 18-64 years from Lifelines was enriched with monthly employment data from Statistics Netherlands. Exit from paid employment during follow-up was defined as a change from paid employment to unemployment, disability benefits, economic inactivity, or early retirement. CHCs included cardiovascular diseases(CVD), chronic obstructive pulmonary disease(COPD), rheumatoid arthritis(RA), type 2 diabetes(T2DM), and depression. Cox-proportional hazards models were used to examine the impact of multimorbidity and combinations of CHCs on exit from paid employment.
Results:
Multimorbidity increased the risk of exiting paid employment compared to workers without CHCs (Hazard Ratio (HR) 1.65; 95%CI: 1.47, 1.84) or one CHC (HR 1.25; 95%CI: 1.11, 1.40). The risk for exit from paid employment increased among workers with COPD if they additionally had CVD (HR 1.40; 95%CI: 1.04, 1.87), depression (HR 1.57; 95%CI: 1.21, 2.05) or RA (HR 1.45; 95%CI: 1.10, 1.90), and for workers with T2DM if they additionally had CVD (HR 1.51; 95%CI: 1.15, 1.99) or depression (HR 2.14; 95%CI: 1.57, 2.92), and for workers with depression who also had T2DM (HR 1.67; 95%CI: 1.23, 2.27).
Conclusion:
This study showed that workers with multimorbidity, especially having a combination of COPD and depression or T2DM and depression, have a higher risk for early exit from paid employment and, therefore, may need tailored interventions at the workplace support.